{
"Npi": {
"NPI": "1336507177",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "J BROADWELL INC",
"ParentOrgTIN": null,
"OrgName": "SEA OF QI FAMILY MEDICINE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "900 N FEDERAL HWY",
"SecondLineMailingAddress": "SUITE 110",
"MailingAddressCityName": "BOCA RATON",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33432-2755",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5967 MICHAUX ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOCA RATON",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33433-7201",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-684-7449",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/08/2016",
"LastUpdateDate": "02/08/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROADWELL",
"AuthorizedOfficialFirstName": "JENNIFER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "AP",
"AuthorizedOfficialTelephoneNumber": "954-684-7449",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "AP3041",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}